HIF Pet
Taking care of your fur babies
Combined product disclosure
statement, policy terms & conditions
and financial services guide.
Issue Date: 28/4/2017
What’s inside?
Welcome to HIF Pet4
Section 4 - Optional Benefit
39
Frequently Asked Questions
6
Product Disclosure Statement
8
Section 5 - General Exclusions
(What we do not cover)
41
• Pre-existing Condition review
• Protection for your pets
• Understanding the limits of the insurance
• Your duty of disclosure
• If you do not tell us something
• Calculating your premium
• Cooling off period
• Your privacy
• Code of practice
• Goods and Services Tax (GST)
• If you have any questions
• If you have a complaint
• Financial Claims Scheme and Compensation
Arrangements
• Authorised for issue
Policy Terms and Conditions
Section 6 - Premiums
• Paying your premium
• Paying on the due date
Section 7 - Cancellations
• Cancellation by us
Section 8 - Claims
• What we will do
• Examples of how we settle your claim
18
• Our rights of recovery
• Other insurance arrangements
Section 9 - Direct Debit Request Summary
52
Section 10 - General Information
53
• Changing level of Cover
21
Section 2 – Your Cover
27
• Basic
• Middle
• Top
2
48
• What you need to do
Section 1 - Definitions
• Emergency Boarding
• Essential Euthanasia
• Pet Overseas Travel Insurance
47
• Cancellation by you
• The HIF Pet policy
• The basis on which we insure you
• Automatic renewal of your policy
• Delivery of your policy documents
• Some important things you should know
Section 3 - Additional Benefits
45
Financial Services Guide (FSG)
54
Financial Services Guide
HIF Pet is promoted by:
Health Insurance Fund of Australia Limited trading as “HIF”
ABN 84 607 276 950, of 100 Stirling Street, Perth, WA, 6847.
HIF is an Authorised Representative of PetSure (AR No. 1250504).
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HIF Pet is arranged and administered through:
PetSure (Australia) Pty Ltd (PetSure) ABN 95 075 949 923, AFSL 420183
of Level 1, 465 Victoria Avenue, Chatswood, NSW 2067.
HIF Pet is issued by:
The Hollard Insurance Company Pty Ltd (Hollard) ABN 78 090 584 473,
AFSL 241436 of Level 12, 465 Victoria Avenue, Chatswood, NSW 2067.
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Welcome to HIF
This policy booklet contains three parts, your:
Financial Services Guide (FSG)
• Product Disclosure Statement
The FSG contains important information about
the services provided by HIF and other persons or
organisations listed in the FSG in relation to HIF Pet,
how they are remunerated in relation to the services
offered, and their internal and external dispute resolution
procedures. It is designed to assist you in deciding
whether to use any of their services. HIF and other
persons or organisations providing the services are
responsible for information relevant to them in the FSG.
• Policy Terms & Conditions
• Financial Services Guide
Product Disclosure Statement (PDS)
The PDS is designed to help you understand what you
need to know about HIF Pet so that you can decide
whether to proceed with this cover. The PDS has been
prepared by Hollard, who is the insurer and product
issuer. Hollard has sole responsibility for the PDS, for
each HIF Pet policy issued, and for the assessment and
payment of claims. PetSure has been given a binding
authority by Hollard which authorises it to enter into,
vary and cancel HIF Pet on behalf of Hollard as if it were
Hollard, subject to the limits of authority agreed with
Hollard.
HIF Pet is not issued or guaranteed by HIF and HIF is
not involved, nor liable, in any manner in respect of the
assessment and payment of benefits under HIF Pet.
The PDS describes the main features and benefits of
HIF Pet. Any information contained in the PDS is general
information only and does not take into account your
individual objectives, financial situation or needs. Before
acting on this general information, you should consider
the appropriateness of the general information having
regard to your individual objectives, financial situation
and needs.
Policy Terms and Conditions
If you have any questions:
Call our friendly customer service team on:
1300 070 946, Monday to Friday (except public holidays)
8:30am to 8:00pm (AEST)
Write to us:
HIF Pet, Locked Bag 9021, Castle Hill, NSW 1765
Visit us: hif.com.au/pet
Email us: [email protected]
Where words or expressions used in the PDS and Policy
Terms and Conditions have a special meaning, we have
used the same terms in both sections. Refer to Section 1 –
Definitions on page 21 for a full explanation.
In addition, references to:
• we, our, us, insurer and Hollard, mean The Hollard
Insurance Company Pty Ltd.
• you and your mean the applicant for a HIF Pet policy
and, if a policy is issued, the insured.
The Policy Terms and Conditions of HIF Pet have been
written in plain language to help you understand the
insurance cover offered, as well as an insured’s rights and
obligations under a HIF Pet policy.
You should carefully read the PDS and the Policy Terms
and Conditions in this booklet before making any
decision about whether to purchase HIF Pet. Note that
you have a cooling off period and certain cancellation
rights.
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Frequently asked questions*
What cover types are offered by HIF?
What waiting periods apply?
HIF offers three different levels of cover that you can
choose from. Details of each level of cover is available in
Section 2 – Your Cover, we have included a brief outline
of our cover:
The Waiting Periods are specified in Section 1 Definitions
on page 26 of this document.
Basic: Cover for Accidental Injury, ingesting foreign
objects, poisoning, toxicity and treatment of paralysis tick
and snake bites.
If any symptoms or signs of a Condition occur or the
Condition exists in any form prior to insurance or during
the applicable Waiting Period, then it will be considered
to be a Pre-existing Condition and it will not be covered.
(Refer to the ‘Pre-existing Condition’, ‘Related Condition’
and ‘Bilateral Condition’ definitions on pages 22 and 24).
Read this document to know what you’re covered for.
Middle: Cover includes all of basic plus Cancer
treatments, Joint luxations/dysplasia’s, Intervertebral disk
disease (IVDD) and some developmental problems.
Read this document to know what you’re covered for.
Top: Our broadest cover that covers eligible Vet
Expenses for your pet suffering any Illness or Accidental
Injury covered by the Policy
Read this document to know what is covered by your
policy.
What percentage of my vet expenses am I
covered for?
We will reimburse you the Benefit Percentage selected
by you which will be shown on your current Certificate of
Insurance. Limits may also apply.
For example, for an 80% Benefit Percentage we will
reimburse you up to 80% of the eligible Vet Expenses.
What Excess applies?
Unlike other pet insurance companies HIF Pet does not
impose or require you to choose an excess – with HIF Pet,
you do not have to pay an Excess because we believe
that this should not reduce your claim payment on your
pet insurance policy.
What is a pre-existing condition?
For example, if your pet shows first signs of cancer prior
to insurance or within the Waiting Period, then cancer will
be considered as Pre-existing and all expenses incurred
for cancer will not be covered.
What is an example of a bilateral condition?
An example would be, if your pet displays clinical signs
of a cruciate ligament Condition in the left leg prior to
insurance or during the Waiting Period (a Pre-existing
Condition), Vet Expenses for a subsequent cruciate
ligament Condition in the right leg will not be covered.
(Refer to the ‘Bilateral Condition’ definition on page 22).
Is my pet eligible for pet insurance?
You can apply for cover as long as your pet meets the
eligibility criteria for the policy you apply for.
What exclusions apply?
As with most insurance products, there are certain
situations where you will not be covered. It is important
that you read all of your policy documentation for full
details (including the Your Cover and General Exclusions
on page 41).
* Information about insurance coverage in this section is a summary only.
You should read the Combined PDS, Policy Terms & Conditions and FSG for
full details of Terms and Conditions, Waiting Periods and Exclusions.
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Product disclosure statement
Hollard is solely responsible for the PDS and is the insurer
under each HIF Pet policy issued. PetSure has been given
a binding authority by Hollard which authorises it to
enter into, vary and cancel HIF Pet on behalf of Hollard
as if it were Hollard, subject to the limits of authority
agreed with Hollard. PetSure does not act for you. HIF is
authorised to distribute and promote HIF Pet but does
not issue policies and is not involved in the assessment or
payment of claims.
Protection for your pets
This PDS contains important information about:
• for eligible Vet Expenses, the use of any Vet in Australia
and, in some cases, overseas.
• significant features and benefits of HIF Pet;
• financial protection for Vet Expenses in respect of the
insured Pet occurring or first showing clinical signs
within the Policy Period and after any applicable
Waiting Period; and
• your Duty of Disclosure when applying for
HIF Pet;
‘Vet Expenses’ are defined in Section 1 – Definitions
on page 25 and may be subject to stated limits and
applicable Waiting Periods.
• our internal and external dispute resolution procedures;
and
Understanding the limits of the insurance
• your cooling off rights when purchasing HIF Pet.
Please note that, while this PDS provides a summary of
the significant features and benefits of HIF Pet, you must
also read the Policy Terms and Conditions in this booklet
to understand the insurance provided (including what
terms, conditions, exclusions and limitations may apply to
your Cover).
Sometimes we need to change the wording of the
policy before it is issued to you because your insurance
varies depending on a number of factors. We do this by
adding what is called an endorsement. You will find any
endorsements that apply to your policy printed on your
Certificate of Insurance.
We may need to update this PDS from time to time
if certain changes occur and where required by law.
If the change results in a material change from the
PDS you hold, we will provide you with a new PDS or
supplementary PDS.
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Subject to the terms, conditions, exclusions and
limitations that apply to your Cover (as set out in this
document), HIF Pet provides:
HIF Pet transfers many of the financial risks pet owners
face for Vet Expenses from the insured to the insurer.
However, HIF Pet does not cover every circumstance
or expense and we have certain terms, conditions,
exclusions and limitations that help keep premiums low.
These include, but are not limited to, conditions such
as pregnancy, elective procedures, pet foods/diets,
grooming and medical conditions that are present or
that you were aware of (or that a reasonable person in
your circumstances should have been aware of) prior
to the policy Commencement Date or that arise during
the applicable Waiting Period. Maximum monetary limits
also apply to the benefits payable in any one Policy
Period. These are called the Benefit Limit and can vary
depending on the relevant cover. Sub-limits for particular
conditions may also apply.
Full details are specified in the Policy Terms and
Conditions (pages 18 to 20).
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Your duty of disclosure
Before you enter into an insurance contract, you have
a duty to tell us anything that you know, or could
reasonably be expected to know, which may affect our
decision to insure you and on what terms. You have this
duty until we agree to insure you. You have the same
duty before you renew, extend, vary or reinstate an
insurance contract.
Minimum premiums and discounts / entitlements may
apply, subject to certain criteria. Discounts / entitlements
/ premiums may be rounded up or down and only apply
to the extent any minimum premium is not reached. They
are also applied in a predetermined order (excluding
amounts for government taxes and charges) as reduced
by any prior applied discounts / entitlements. They are
applied to the base premium calculated prior to any
taxes being added.
You do not need to tell us anything that:
• reduces the risk we insure you for; or
• is common knowledge; or
• we know or should know as an insurer; or
• we waive your duty to tell us about.
If you do not tell us something
If you do not tell us anything you are required to, we may
cancel your contract or reduce the amount we will pay
you if you make a claim, or both.
If your failure to tell us is fraudulent, we may refuse to
pay a claim and treat the contract as if it never existed.
Calculating your premium
Your premium is calculated when your HIF Pet policy
begins, and at each policy anniversary (and if you vary or
extend cover) and is printed on the relevant Certificate of
Insurance.
The premium is calculated based on a number of factors.
Some are pre-set and don’t vary for each insured (e.g.
amounts we take into account for certain internal costs
and expenses). Others can affect the premium amount
up or down depending upon whether we believe it
increases or decreases the risk to us, such as the Cover
you have chosen, the Benefit Percentage applicable to
the Cover you have chosen, where you and your Pet
permanently live and the species, breed and age of
your Pet. The amount you pay includes allowances for
government fees, taxes and charges (including stamp
duty and GST). You can ask us for further information.
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Cooling off period
You have a full 21 days from the policy Commencement
Date (or any renewal date) to make sure you are happy
with every aspect of your HIF Pet policy. This is known as
the “cooling off” period. During this time you may cancel
the policy simply by contacting to us. If we receive your
request to cancel your policy within the 21 day period
after the policy Commencement Date (or any renewal
date), we will give you a refund of any monies received
since commencement or renewal, less any reasonable
administrative and other transaction costs incurred by us,
which we are unable to recover and any taxes or duties
that we are unable to refund.
You cannot return your HIF Pet policy if you have
exercised any of your rights or powers under the policy
(e.g. you have made a claim) within the 21 day cooling off
period. After the cooling off period ends you continue to
be able to cancel your policy and you have rights upon
cancellation in certain circumstances under the policy.
These rights are set out in Section 7 – Cancellations on
page 47.
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Your Privacy
Hollard, HIF and PetSure (each a “Recipient” and referred
to as “we”, “us” or “our” in this Privacy section) are
subject to the Australian Privacy Principles under the
Privacy Act (Cth) 1988.
In connection with each Recipient:
• personal information is collected in various ways,
including via telephone, our website, hard copy forms
or email. Whenever you deal with us we will collect this
information directly from you unless it is unreasonable
or impracticable for us to do so. In some instances
we may collect your information from someone else.
This may include our authorised representatives, our
distributors or referrers, agents or related entities,
veterinary service providers, another party involved in
a claim, family members, anyone you have authorised
to deal with us on your behalf, and/or our legal or other
advisers;
• personal information is collected that is reasonably
necessary in order for us to provide and offer you
our products and services, or otherwise as permitted
by law. Such purposes include responding to your
enquiries, providing you with assistance you request
of us, maintaining and administering our products
and services (for example processing requests for
quotes, applications for insurance, underwriting and
pricing policies, issuing you with a policy, managing
claims, processing payments); processing your
survey or questionnaire responses; market research
and the collection of general statistical information
using common internet technologies such as cookies;
providing you with marketing information regarding
other products and services (of ours or a third party);
quality assurance and training purposes; performing
administrative operations (including accounting and
risk management) and any other purpose identified at
the time of collecting your information;
• If you do not consent to us collecting and using, or
disclose all or some of the personal information we
request, we may not be able to provide you with
our products or services, such as processing your
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application for insurance, your claim or any payment
due to you. It may also prevent us from maintaining
or administering your policy or the provision of
information regarding our products or services or
those of any third party;
• From time to time, HIF may also collect and use your
personal information so that it can promote and
market its products or services to you and as well as
those of its related entities, and other third parties,
including by direct mail, SMS and MMS messages, by
phone and email. If you do not want to be contacted,
please let HIF know by contacting them (contact
details are provided in this section);
• Where appropriate, we will disclose your information
to our related entities and third parties who provide
services to us or on our behalf, including our authorised
representatives, distributors or referrers, mailing
houses and marketing companies, insurance reference
bureaus, reinsurers, credit providers, external IT service
providers, other insurance providers and advisers. In
the case of claims (or likely claims) it may be disclosed
to persons involved in the claim, veterinary service
providers, external claims data collectors and verifiers.
Your personal information may also be disclosed to
the Financial Ombudsman Service or other dispute
resolution providers, government bodies, regulators,
law enforcement agencies and any other parties where
required by law;
• Your personal information may also be disclosed
to some of our service providers and in the case of
PetSure, some of these may be located overseas,
including but not limited to the Philippines. Details of
who they are may change from time to time. You can
contact PetSure for details. In some cases we may
not be able to take reasonable steps to ensure they
do not breach the Privacy Act and they may not be
subject to the same level of protection or obligations
that are offered by the Act. By proceeding to acquire
our services and products you agree that you cannot
seek redress under the Act or against us (to the extent
permitted by law) and may not be able to seek redress
overseas.
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You consent to the use and disclosure of your personal
information as set out in this section. Your consent
applies whether you become or remain the insured
unless you tell us otherwise by contacting us. You can
read more about how we collect, use and disclose
your personal information or how to make a complaint
about a breach of the Australian Privacy Principles in
our respective Privacy Policy which is available on our
website or you can request a copy. If you wish to gain
access to your personal information (including correcting
or updating it), have a complaint about a breach of
your privacy or have any other query relating to privacy,
please contact the Privacy Officer at:
Hollard
Telephone: 13 19 48
Email: [email protected]
Mail: Hollard Privacy Officer The Hollard Insurance
Company Pty Ltd Locked Bag 2010, St Leonards,
NSW 1590
Website: hollard.com.au
HIF
Telephone: 1300 070 946
Email: [email protected]
Mail: HIF Privacy Officer HIF Pet at Locked Bag
9021,Castle Hill, NSW 1765 or e-mail [email protected]
Website: hif.com.au/pet
PetSure
Telephone: (02) 9842 4800
Code of practice
We are a member of the Insurance Council of Australia
and also a signatory of the General Insurance Code of
Practice. The objectives of the Code are to:
• commit insurers to high standards of service;
• promote better, more informed relations between
insurers and their customers;
• maintain and promote trust and confidence in the
general insurance industry;
• provide fair and effective mechanisms for the
resolution of complaints and disputes between insurers
and their customers; and
• promote continuous improvement of the general
insurance industry through education and training.
You can obtain a copy of the Code from the Insurance
Council of Australia website at insurancecouncil.com.au.
Goods and services tax (GST)
All monetary limits in your policy are inclusive of GST. In
the event of a claim, if you are not registered for GST, we
will reimburse you the GST component in addition to the
amount we pay you. If you are registered for GST, we will
not pay you the GST component, you will need to claim
the GST component from the Australian Taxation Office.
You must advise us of your correct input tax credit
percentage where you are registered as a business and
have an Australian Business Number. You are liable to us
for any GST liability we incur arising from your incorrect
advice or inaction.
Email: [email protected]
If you have any questions
Mail: PetSure Privacy Officer PetSure (Australia) Pty Ltd
Locked Bag 9021,Castle Hill, NSW 1765
For more information about HIF Pet, to confirm policy
transactions, or if you have any questions about the
information contained in the PDS or Policy Terms and
Conditions, please call us on 1300 070 946.
Website: petsure.com.au
Our lines are open Monday to Friday (except public
holidays) 8:30am to 8:00pm (AEST). Alternatively, you can
write to HIF Pet, Locked Bag 9021, Castle Hill NSW 1765.
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If you have a complaint
Financial Ombudsman Service
We hope that you never have reason to complain, but if
you do we will do our best to work with you to resolve it.
Our complaints resolution process has three steps.
Mail: GPO Box 3, Melbourne VIC 3001
1 – Immediate Response
Usually when you have a concern, we can resolve it
immediately on the phone. If we can’t immediately
resolve your concern we will treat it as a complaint and
take steps to resolve your matter as soon as possible.
Please contact us using one of the following means:
Phone: 1300 070 946 (Weekdays between 8:00am and
8:00pm AEST – except public holidays)
Writing: Customer Service Complaints HIF Pet Locked
Bag 9021 Castle Hill NSW 1765
Please supply your policy number to enable the enquiry
to be dealt with promptly. Your complaint or enquiry will
be dealt with by someone with appropriate authority.
2 – Internal Dispute Resolution
If we haven’t resolved your matter to your satisfaction,
at your request (refer to contact details provided for “1 –
Immediate Response”), we will escalate your complaint
for review by our Internal Disputes Resolution team.
All escalated matters will be acknowledged within 2
business days of being escalated. After full consideration
of the matter a written final response will be provided
that will outline the decision reached and the reasons for
the decision.
3 – External Dispute Resolution
In the unlikely event that your complaint is not resolved
to your satisfaction, or a final response has not been
provided within 45 days, you may be eligible to refer
your matter to the Financial Ombudsman Service (FOS),
providing your matter is within the scope of the FOS
Terms of Reference. The FOS is an independent dispute
resolution service provided free of charge. You may
contact the FOS at:
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Phone: 1800 367 287 (local fee applies)
Fax: (03) 9613 6399
Website: fos.org.au
Email: [email protected]
Financial claims scheme and compensation
arrangements
We are an insurance company authorised under the
Insurance Act 1973 (Cth) (Insurance Act) to carry on
general insurance business in Australia by the Australian
Prudential Regulation Authority (APRA) and are subject
to the prudential requirements of the Insurance Act.
The Insurance Act contains standards designed to
ensure that, under all reasonable circumstances, financial
promises made by us are met within a stable, efficient
and competitive financial system. Because of this we are
exempted by the Corporations Act 2001 (Cth) from the
requirement to meet the compensation arrangements
Australian Financial Services licensees must have in place
to compensate retail clients for loss or damage suffered
because of breaches by the licensee or its representatives of
Chapter 7 of that Act. We have compensation arrangements
in place that are in accordance with the Insurance Act.
If we were to fail and were unable to meet our obligations
under your policy, a person entitled to claim under
insurance cover under the policy may be entitled to
payment under the Financial Claims Scheme (access to
the Scheme is subject to eligibility criteria). Information
about the Financial Claims Scheme can be obtained from
the APRA website at fcs.gov.au and the APRA hotline on
1300 558 849.
Authorised for issue
This PDS including the Policy Terms and Conditions was
prepared by Hollard. HIF and PetSure have given their
consent to all statements by or about them in the form
and context in which they are included and have not
withdrawn as at the date of the PDS. These statements
appear throughout the PDS.
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Policy terms & conditions
The HIF Pet policy
Automatic Renewal of your Policy
Upon acceptance of application for your Cover, you will
be issued a Certificate of Insurance. We will issue a new
Certificate of Insurance:
We will advise you regarding renewal of your policy prior
to the expiration of the current policy. We may change
the terms and conditions of the policy upon renewal to
reflect the portion of the risk associated with insuring
your Pet based on factors such as (but not limited to)
your Pet’s age, location and medical history, as well as
any changes we make to the policy or the level of Cover.
• on renewal of your policy each year; or
• if you or we change your Cover.
Your policy will continue for a period of twelve (12) months
from the policy Commencement Date unless cancelled
by you under the cooling off period as explained on page
11 or cancellation provisions of the policy as explained
in Section 7 – Cancellations on page 47. We also have
certain cancellation rights by law. For your convenience
and to ensure continuity of cover for your Pet, we will
automatically renew your policy each year, refer to the
“Automatic renewal of your policy” section on page 19.
Your policy comprises of the Certificate of Insurance,
PDS, Policy Terms and Conditions, FSG and any
endorsements issued by us from time to time.
The basis on which we insure you
Subject to the Terms and Conditions of the policy, we will
reimburse the Vet Expenses incurred by you as a result of
a Treatment to the insured Pet as per your selected cover
up to the specified Benefit Percentage, but subject to any
applicable Benefit Limit which may apply, provided that:
• you have paid or agreed to pay the premium to us for
the Cover provided;
• the Condition(s) arose during the Policy Period; and
• the Treatment occurred during the Policy Period.
Where we agree to provide Cover under the policy we
rely on the representations made by you during your
application for insurance.
Coverage under the policy will depend on the level of
Cover you have chosen. Your Certificate of Insurance will
state your Pet level of cover as detailed in Section 2 on
page 27.
Unless otherwise notified, your Cover will be
automatically renewed on the terms contained in the
renewal offer and we will deduct/charge the renewal
premium from your nominated account/credit card
unless you tell us not to. If the account/credit card is not
yours, you confirm you have the authority of the relevant
person to use it and they have agreed to these terms.
We require you to notify us should you decide not to
renew your policy.
On renewal, you must tell us if the information you have
previously supplied is incorrect or incomplete in order to
comply with your Duty of Disclosure. If you do not we
may reduce or refuse to pay a claim or cancel the policy.
Delivery of your policy documents
Unless you tell us otherwise or we tell you it is no
longer suitable we will send your policy documents
and policy related communications electronically. This
includes email and/or other methods of electronic
communication. You will need to provide us with your
current email address and your mobile phone number.
Each electronic communication will be deemed to be
received by you on the transmission date recorded in our
systems. Where we deliver your policy documents and
policy related communications by mail in printed form
all such communications will be deemed to have been
successfully delivered once mailed by us to your last
notified postal address.
Additional and optional benefit(s) may also be provided
if specified on your Certificate of Insurance.
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Section 1 Definitions
Some important things you should know
Benefits do not accumulate across Policy Periods. The
policy benefits will expire at the end of each Policy
Period.
Your rights and duties under the policy cannot be
transferred without our prior written consent.
It is a condition of cover that your Pet must regularly
reside with you and be under your regular care and
supervision at the physical address you provided to us.
When interpreting these Policy Terms and
Conditions:
• references to the singular include the plural and vice
versa, and to the masculine include the feminine and
vice versa; and
• monetary references are in Australian dollars.
Accidental Injury means physical harm or injury arising
from an accident. For the purposes of this policy, an
accident is:
• a single specific, unpredictable, unusual and
unintended external event which occurs at a particular
time and place, with no apparent or deliberate cause
but with marked effects; and
• is independent of any other cause including any
Pre-existing Condition.
Note: Conditions covered by the Accidental Injury Cover Section of the
policy are specified in Section 2 on page 27.
Benefit Limit(s) means the applicable total amount
payable under your policy in relation to the relevant
Cover as specified in your Certificate of Insurance
(determined as follows);
• if a specified limit or sub limit for a particular Cover,
item, condition or treatment on an individual or per
claim basis is specified to apply in the Certificate of
Insurance, we will not pay more than that amount
(subject also to the following annual limits and sub
limits not having been exceeded); and
• we will never pay more than the overall annual benefit
level specified in your Certificate of Insurance, unless
a special annual limit or annual sub limit is specified
as applicable to the particular Cover, item, condition
or treatment (in which case the lesser annual limit or
annual sub limit will apply).
Benefit Percentage means the stated percentage of
each claim for eligible Vet Expenses for which we will
reimburse you and subject to any applicable Benefit
Limits. Note: The applicable Benefit Percentage will be
shown on your Certificate of Insurance.
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For example: for an 80% Benefit Percentage we will
reimburse you for 80% of the eligible Vet Expenses and
subject to Benefit Limits payable. Refer to page 50 for an
example of how claim payments are calculated.
Bilateral Condition means any Condition affecting body
parts of which the Pet has at least two, one each side
of the body (e.g. ears, eyes, knees, cruciate ligaments).
Note: When applying a Benefit Limit or exclusion, a
Bilateral Condition will be considered a single Condition.
For example: if your Pet displays clinical signs of a
cruciate ligament Condition in the left leg prior to the
Commencement Date of the policy or during the Waiting
Period, Vet Expenses for a subsequent cruciate ligament
Condition in the right leg will not be covered.
Certificate of Insurance means the relevant certificate
we provide outlining the key details of the contract of
insurance between you and us, and identifying the policy
number, Commencement Date, Cover End Date, insured
Pet, schedule of benefits including Benefit Limits.
Commencement Date means 23h59 on the date when
Cover for your Pet first started as shown on your
Certificate of Insurance.
Condition means any Accidental Injury, or any
manifestation of an Illness.
Consultation and other derivations means an
examination performed by or under the supervision
of a Vet, including a physical consultation, inpatient
Examination, in-hospital examination, health certificate,
consultation or recheck consultation/ visit, referral/
specialist consultation/ visits, emergency and after hours
consultations/ visits.
Cover means the cover applicable to the policy you have
selected. Information about the cover can be found in
Section 2.
Note: The Cover applying to your Pet is shown on
your Certificate of Insurance. The Cover includes the
Additional Benefits explained in Section 3 on page 37
and if selected the Optional Benefit explained in Section
4 on page 39.
22
Elective Treatment means a Treatment or surgery that
is beneficial to your Pet but is not essential for your Pet’s
survival or does not form part of the Treatment for a
Condition. Refer to Section 5 – General Exclusions on
page 41.
End Date means 23h59 on the date upon which your
policy terminates and benefits cease. Note: The End Date
is shown on your Certificate of Insurance. If the policy is
cancelled, then the date of cancellation will be deemed to
be the End Date.
GST means the Australian Goods and Services Tax at the
officially published tax rate.
Illness means a sickness or disease.
Pet means a dog or cat covered under the policy and
named on your Certificate of Insurance.
Policy Period means the time during which we provide
Cover as specified on your Certificate of Insurance.
Pre-existing Condition means any Condition(s) or
symptoms or signs of that Condition occurring or
existing in any form prior to the Commencement Date or
during any applicable Waiting Period. Including but not
limited to:
• any cruciate ligament Condition;
• a recurring condition
• any Skin Condition (as defined);
• latent infectious Conditions that manifest within a
known incubation period indicating clear evidence that
the Condition had existed prior to the Commencement
Date;
• any Condition in remission at the time of the insurance
application;
• any seasonal Condition;
• Conditions currently or previously being controlled by
medication(s);
and whether or not diagnosed or treated by a Vet.
(If your Pet has a Pre-existing Condition, please also refer
to definitions for a “Related Condition” and a “Bilateral
Condition”).
23
Related Condition means a Condition that even though
it has shown first signs or symptoms during the Policy
Period (outside of the Waiting Period), is considered
to be a Pre-existing Condition if it has the same clinical
symptoms, diagnostic classification or results from
the same disease process as a Pre-existing Condition
regardless of the number of areas of your Pet’s body
affected.
For example: if your Pet suffers from arthritis in its legs
prior to the Commencement Date of the policy or during
the Waiting Period, all future occurrences of arthritis for
example in the back or neck, will be considered to be
Related Conditions and will not be covered.
Routine Care means stated benefits provided for certain
listed preventative healthcare treatments for your Pet.
The list of allowable treatments and the benefit amounts
applicable to these are shown on your Certificate of
Insurance.
Treatment means reasonable and customary
examinations, consultations, hospitalisation, surgery,
x-rays, medication, diagnostic tests, nursing and other
care and procedures provided by a Vet to relieve or cure
a disease, Illness or Accidental Injury during the Policy
Period.
Vet means any veterinarian, veterinary specialist, animal
hospital, animal clinic, or animal surgery, other than
yourself, who is licensed in and currently registered
in Australia (with the exception of additional benefits
provided under Section 3).
Vet Expenses means the reasonable, customary and
essential expenses incurred and paid in respect of
Treatment provided by a Vet during the Policy Period.
Skin Condition means any Condition regardless of cause
or origin presenting in or affecting the skin (as an organ)
in any way whatsoever. Note: For the purposes of the
policy Skin Conditions are:
• deemed to include skin lumps;
• regarded as one Condition.
Surgical Repair means a medical procedure involving
an incision with instruments; performed by Vet to repair
damage or arrest disease in a living body.
Trauma means physical harm or injury arising from a
single specific, unpredictable, unusual and unintended
external event which occurs at a particular time and
place, with no apparent or deliberate cause but with
marked effects; and
is independent of any other cause including any
Pre-existing Condition.
24
25
Section 2 Your cover
Waiting Period means a period starting from the
Commencement Date of the first Policy Period during
which a Condition that occurs or shows symptoms or
signs will be excluded from Cover unless otherwise stated
on your Certificate of Insurance.
Items
Motor vehicle incident
Waiting period
nil
Burns
2.1.1 Eligibility Criteria
Basic is applicable if:
• it is shown on your Certificate of Insurance; and
• The
Cover applying to your Pet is shown on your
Certificate of Insurance. The Cover includes the
Additional Benefits explained in Section 3 on page
37 and if shown on your Certificate of Insurance the
Optional Benefit explained in Section 4 on page 39.
Allergic reaction to an insect bite
(other than flea or tick bites)
Bone fractures
Snake bite
Lacerations
2.1.2 What you are covered for
Torn nail
30 days
Eye Trauma
Trauma induced respiratory
impairment
Soft tissue injury
We will pay you the Benefit Percentage for the Vet
Expenses incurred by you for Treatment during the
Policy Period up to the Benefit Limits, as a result of your
Pet suffering a Condition in one of the circumstances
described below.
To qualify for Cover under this section of the policy, the
Condition must have occurred during the Policy Period
and meet one of the criteria below
Ingestion of foreign object
Traumatic disc rupture/Intervertebral
disc disease (IVDD)
(1) A
Condition
as a direct
consequence
of one of the
following:
Paralysis Tick bite
Gastic dilatation-volvulus (GDV)
Hip & Patella conditions
Brachycephalic Airway Syndrome and
related Conditions
a) a motor vehicle incident
b) a burn or electrocution
c) allergic reaction to insect bite
excluding flea bites
d) Ingestion of foreign object
e) tick paralysis
Cancer
f) heat stroke
All other Illness Conditions
g) gastric
dilation-volvulus (GDV)
Cruciate ligament Conditions
Dental Illness
26
2.1 – Basic
• your
Pet was at least 8 weeks of age at the
Commencement Date.
Electrocution
Heat stroke
You can choose from 3 levels of cover.
You are only covered for:
6 months
h) Trauma induced respiratory
impairment
27
(2) A
Condition
resulting in:
i) a bone fracture
j) snake bite toxicity
k) a traumatic ligament or tendon
injury
l) a bite wound or fight wound
abscesses
m) lacerations or abrasion of tissue,
skin or mucous membrane due to
external violence
n) traumatic spinal disc rupture
o) torn nail
p) poisoning
3. more than one (1) incident of swallowing a foreign
object that causes a blockage or obstruction requiring
surgical or endoscopic removal per Policy Period; or
4. any tick preventative treatments or measures
(eg tick baths, sprays, etc) whether recommended by
your Vet or not.
5. any of the exluded matters listed in Section 5 General Exclusions on page 41.
6.other Illness not stated no matter how the Condition
arises;
7. patella luxations (dislocating kneecap) and elbow
dysplasia no matter how the Condition arises.
q) embedded grass seed
2.1.4 Waiting Period:
r) soft tissue injury
1. The Waiting Period is defined in Section 1 Definitions.
s) eye Trauma
t) Cruciate Ligament Condition
Your Benefit Limits, as well as any sub-limits that may
apply, is shown on your Certificate of Insurance.
2.1.3 When you are not covered
We will not pay any Vet Expenses attributable to or
resulting from:
1. T
reatment of the following irrespective of whether your
dog or cat was vaccinated or not:
a. f or dogs: infectious canine hepatitis (canine
adenovirus), parvovirus, canine distemper,
parainfluenza and all forms of kennel cough; or
b. f or cats: panleukopaenia, chlamydia, leukaemia
(FeLV), Feline Immuno Deficiency Virus (FIV) and
Feline Infectious Peritonitis (FIP), viral rhinotracheitis,
calicivirus, herpes virus and all forms of cat flu;
2. Cruciate ligament Conditions and any Conditions
arising therefrom irrespective of cause or origin, are
subject to the Waiting Period, unless:
-w
e have received a completed and signed ‘Cruciate
Ligament Exam Form’ from your Vet within fourteen
(14) days of the cruciate examination date certifying
that your Pet has been examined, at your expense, on
or after the policy Commencement Date; and
- you receive written notification from us confirming
our agreement to waive this Waiting Period following
our assessment of the information provided on the
‘Cruciate Ligament Exam Form’.
Any waiver is at our discretion and we are not required
to provide justification for declining a request under this
provision.
2. a
ny declared pandemic disease that causes
widespread Illness affecting dogs or cats;
28
29
Section 2.2 - Middle
2.2.1 Eligibility Criteria
Middle is applicable if:
• it is shown on your Certificate of Insurance; and
• your
Pet was over 8 weeks old and younger than 9
years of age when Cover first commenced.
Pets over 9 years of age will not qualify for Middle Cover
where there has been a break, lapse or change in the
level of Cover after reaching the age of 9.
he Cover applying to your Pet is shown on your
T
Certificate of Insurance. The Cover includes the
Additional Benefits explained in Section 3 on page
37 and if shown on your Certificate of Insurance the
Optional Benefit explained in Section 4 on page 39.
2.2.2 What you are covered for
We will pay you the Benefit Percentage for the Vet
Expenses incurred by you for Treatment during the Policy
Period up to the Benefit Limits, as a result of your Pet
suffering one of the circumstances described below.
To qualify for Cover under this section of the policy,
the Condition must have occurred during the Policy
Period and one of the criteria below
(1) A
Condition
as a direct
consequence
of one of the
following:
a) a motor vehicle incident
b) a burn or electrocution
c) allergic reaction to insect bite
excluding flea bites
d) ingestion of foreign object
e) tick paralysis
f) heat stroke
g) gastric
dilation-volvulus (GDV)
h) Trauma induced respiratory
impairment
(2) A
Condition
resulting in:
i) a bone fracture
j) snake bite toxicity
k) a traumatic ligament or tendon
injury
l) a bite wound or fight wound
abscesses
m) lacerations or abrasion of tissue,
skin or mucous membrane due to
external violence
30
31
(2) A
Condition
resulting in:
n) traumatic spinal disc rupture
o) torn nail
p) poisoning
q) embedded grass seed
r) soft tissue injury
s) eye Trauma
4. a
ny tick preventative treatments or measures (eg tick
baths, sprays, etc) whether recommended by your Vet
or not.
ny of the excluded matters listed in Section 5 –
5. a
General Exclusions on page 41.
6. o
ther Illness not stated no matter how the Condition
arises;
t) cancer
u) hip or elbow dysplasia
v) patella luxation
w) stenotic nares, soft palate
resections, everted laryngeal
saccules
x) entropion and ectropion surgery
y) Cruciate Ligament Condition
Your Benefit Limits, as well as any sub-limits that may
apply, is shown on your Certificate of Insurance.
2.2.3 When you are not covered
We will not pay any Vet Expenses incurred by you as a
result of your Pet suffering an Illness which is attributable
to or resulting from:
1. Treatment of the following irrespective of whether your
dog or cat was vaccinated or not:
a. for dogs: infectious canine hepatitis (canine
adenovirus), parvovirus, canine distemper,
parainfluenza and all forms of kennel cough; or
2.2.4 Waiting Period:
1. The Waiting Period is defined in Section 1 Definitions.
2. C
ruciate ligament Conditions and any Conditions
arising therefrom irrespective of cause or origin, are
subject to waiting period, unless:
e have received a completed and signed ‘Cruciate
-w
Ligament Exam Form’ from your Vet within fourteen
(14) days of the cruciate examination date certifying
that your Pet has been examined, at your expense, on
or after the policy Commencement Date; and
-y
ou receive written notification from us confirming
our agreement to waive this Waiting Period following
our assessment of the information provided on the
‘Cruciate Ligament Exam Form’.
Any waiver is at our discretion and we are not required
to provide justification for declining a request under this
provision.
b. for cats: panleukopaenia, chlamydia, leukaemia
(FeLV), Feline Immuno Deficiency Virus (FIV) and
Feline Infectious Peritonitis (FIP), viral rhinotracheitis,
calicivirus, herpes virus and all forms of cat flu;
2. any declared pandemic disease that causes
widespread Illness affecting dogs or cats;
ore than one (1) incident of swallowing a foreign
3. m
object that causes a blockage or obstruction requiring
surgical or endoscopic removal per Policy Period; or
32
33
2.3 – Top
2.3.1 Eligibility Criteria
Top is applicable if:
• it is shown on your Certificate of Insurance; and
(2) A
Condition
as a direct
consequence
of one of the
following:
• your
Pet was over 8 weeks old and younger than 9
years of age when Cover first commenced.
2.3.2 What you are covered for
If you have selected Top we will pay you the Benefit
Percentage for the Vet Expenses incurred by you for
Treatment during the Policy Period up to the Benefit
Limits, as a result of your Pet suffering an Accidental
Injury or Illness.
Your Benefit Limits, as well as any sub-limits that may
apply, is shown on your Certificate of Insurance.
To qualify for Cover under this section of the policy,
the Condition must have occurred during the Policy
Period and meet one of the criteria below
(1) A
Condition
as a direct
consequence
of one of the
following:
f) snake bite toxicity
g) a traumatic ligament or tendon
injury
h) a bite wound or fight wound
abscesses
i) lacerations or abrasion of tissue, skin
or mucous membrane due to external
violence;
• Pets
over 9 years of age will not qualify for Top Cover
where there has been a break, lapse or change in the
level of Cover after reaching the age of 9.
• The
Cover applying to your Pet is shown on your
Certificate of Insurance. The Cover includes the
Additional Benefits explained in Section 3 on page
37 and if shown on your Certificate of Insurance the
Optional Benefit explained in Section 4 on page 39.
e) a bone fracture
j) intervertebral disc disease
k) poisoning
l) cruciate ligament repair
(3) A
Condition as
a result of:
m) your pet suffering an Illness
n) a bite from a paralysis tick (Ixodes
holocyclus)
2.3.3 When you are not covered
We will not pay any Vet Expenses attributable to or
resulting from:
1. Treatment of the following irrespective of whether your
dog or cat was vaccinated or not:
a. for dogs: infectious canine hepatitis (canine
adenovirus), parvovirus, canine distemper,
parainfluenza and all forms of kennel cough; or
b) a burn or electrocution
b. for cats: panleukopaenia, chlamydia, leukaemia
(FeLV), Feline Immuno Deficiency Virus (FIV) and
Feline Infectious Peritonitis (FIP), viral rhinotracheitis,
calicivirus, herpes virus and all forms of cat flu;
c) allergic reaction to insect bite
excluding flea bites
2. any declared pandemic disease that causes
widespread Illness affecting dogs or cats;
d) Ingestion of foreign object
3. more than one (1) incident of swallowing a foreign
object that causes a blockage or obstruction requiring
surgical or endoscopic removal per Policy Period; or
a) A motor vehicle incident
ny tick preventative treatments or measures (eg tick
4. a
baths, sprays, etc) whether recommended by your Vet
or not.
34
35
Section 3 Additional benefits
5. any of the excluded matters listed in Section 5 –
General Exclusions on page 41.
2.3.4 Waiting Period
1. The Waiting Period is defined in Section 1 Definitions.
2. C
ruciate ligament Conditions and any Conditions
arising therefrom irrespective of cause or origin, are
subject to the Waiting period, unless:
e have received a completed and signed ‘Cruciate
-w
Ligament Exam Form’ from your Vet within fourteen
(14) days of the cruciate examination date certifying
that your Pet has been examined, at your expense, on
or after the policy Commencement Date; and
-y
ou receive written notification from us confirming
our agreement to waive this Waiting Period following
our assessment of the information provided on the
‘Cruciate Ligament Exam Form’.
Any waiver is at our discretion and we are not required
to provide justification for declining a request under this
provision.
The following Additional Benefits under this
section are included on all levels of cover
defined in Section 2. The Benefit Limit will
provide benefits up to the specified sub-limit
as shown on your Certificate of Insurance.
3.1 Emergency Boarding
What you are covered for
If you, (the insured and sole carer of the Pet) are
hospitalised (other than in the circumstances specified
below) for five (5) or more consecutive days during the
Policy Period, we will pay for the cost of boarding your
Pet at a licensed kennel or cattery up to the Benefit Limit.
We will not pay
1. If you are hospitalised for:
a. cosmetic surgery or other forms of elective surgery;
b. pregnancy; or
c. any sickness known or foreseeable prior to the
Commencement Date;
2. Any costs under this benefit if someone else living with
you can reasonably be expected to look after your Pet
whilst you are in hospital.
3.2 Essential Euthanasia
What you are covered for
We will pay you the Benefit Percentage for Vet Expenses
incurred by you up to the Benefit Limit to euthanase your
Pet during the Policy Period provided that this was deemed
a humane and essential course of action by the Vet.
When you are not covered
We will not pay any Vet Expenses incurred by you during
the Policy Period for:
1. voluntary euthanasia (i.e. non-essential euthanasia);
36
37
Section 4 Optional benefits
2. euthanasia attributable to or resulting from an event
or circumstances specified within Section 2 “When you
are not covered” and in Section 5 – General Exclusions
on page 41;
3. an autopsy; or
4. d
isposal, burial or cremation of a deceased Pet (unless
cover for this expense is noted on your Certificate of
Insurance).
3.3 Pet Overseas Travel Insurance
What you are covered for
We will pay for Vet Expenses incurred for the Treatment
of your Pet whilst it is overseas with you in destinations
where Australian quarantine regulations do not require
the Pet to be quarantined on its return, subject to:
the
Cover selected, the Benefit Percentage and
Benefit Limits as shown on your applicable
Certificate of Insurance; and
the
payment of the benefits under this section to
you in AUD at the exchange rate applicable on the
date your claim is received by us.
When you are not covered
1. a
ny amount if you or your Pet live permanently outside
of Australia;
2. a
ny benefit under this section where the Pet has been
(or is going to be) out of Australia for a period of more
than sixty (60) consecutive days;
3. e
xchange commissions or bank charges incurred for
foreign payments made by you for the Treatment of
your Pet;
4. c
laims incurred for any Condition arising when your
Pet was not under your direct care;
4.1 Routine Care
HIF encourages responsible Pet ownership by providing
stated benefits towards certain listed preventative
healthcare treatments for your Pet if the Routine Care
benefit option is shown on your Certificate of Insurance.
What you are covered for
If the Routine Care Benefit option is shown on your
Certificate of Insurance, we will pay the cost of Routine
Care your Pet has received during the Policy Period up
to the Routine Care limits as shown on your applicable
Certificate of Insurance.
4.2 Dental Illness Benefit
If the Dental Illness Benefit option is shown on your
Certificate of Insurance, you will be covered for certain
Dental Illness treatment.
4.2.1 What we will pay
We will pay you the Benefit Percentage for Vet Expenses
incurred by you for treatment provided during the Policy
Period up to the sub-limit shown (for Dental Illness
Benefit) on your Certificate of Insurance, as a result
of your Pet requiring Dental Illness treatment for the
following conditions described below:
1. Gingivitis;
2. Abscesses;
3. Removal of teeth where medically necessary due to:
a) dental disease arising from infection
b) retained deciduous teeth
c) cavities
d) tooth fracture
5. c
osts covered by any other insurance policy covering
the same risk; or
6. a
ny travel or repatriation charges to return your Pet to
Australia.
38
39
Section 5 General exclusions
(What we do not cover)
4.2.2 We will not pay
1. for any dental illness treatment unless your pet has
been insured under this policy for at least six (6) months
and in this period your pet has not shown signs of or
been treated for any dental illness;
The intention of HIF Pet is to help cover
unforeseen vet expenses associated with
pet ownership. However not all expenses
are covered.
2. for any dental illness treatment unless there is a history
of annual routine dental check-ups by a Vet;
Unless stated on your Certificate of Insurance, Vet
Expenses and/or costs related to the following are not
covered on all levels of cover defined in Section 2:
3. for orthodontic treatment, crowns; root canal, cosmetic
dental surgery or corrective treatment; odontoclastic
resorptive lesions;
1. Pre-existing Conditions
4. for any dental illness treatment or Related Conditions
unless your Pet is covered under your policy in Section
2; or
5. any of the exclusions explained in Section 6 – General
Exclusions on page 41.
A related Condition or a Condition arising within the
applicable Waiting Period. Refer to page 23 for definition
of Pre-existing Conditions. Also refer to the ‘Pre-existing
Condition review’ section on page 44.
2. Dental Care
Dental procedures; dental diseases; gingivitis; Treatment
of teeth fractures; teeth cleaning/scaling; orthodontics;
removal of deciduous or fractured teeth or any oral
disease.
3. Day to Day Care
a. r egular, prescription or dietary pet food, vitamins,
nutraceuticals, or supplements, whether recommended
by your Vet or not;
b. p
reventative procedures and treatments (including, but
not limited to, vaccinations, microchipping, routine anal
gland expression, flea/tick/worm control or motion
sickness medication);
c. g
rooming and bathing of your Pet (including
medicated baths and shampoos);
d. accessories such as but not limited to - pill poppers,
cage hire, crates, bedding and collars;
e. t raining, socialisation, therapy and alternative therapies
(including, but not restricted to, consultations
and Treatments involving homeopathic remedies,
acupuncture, laser therapy, hydrotherapy, chiropractic
treatments and/or physiotherapy) whether
recommended by your Vet or not; or
40
41
f. Treatment while your Pet is used for commercial or
occupational purposes including but not limited to
racing, breeding, organised fighting, law enforcement,
guarding or pig hunting dogs. Guide Dogs and
Assistance Dogs are exempt from this exclusion.
5. Certain Services & Procedures
a. t ransport or boarding expenses other than the benefits
provided in Section 3.1 – Emergency Boarding on page
37, regardless of reason;
b. ambulance fees and non-essential hospitalisation;
4. Certain Treatments & Conditions
a. Treatment of or Conditions attributable to behavioural
problems regardless of the cause (including but not
limited to anxiety disorders, phobias or chemical
imbalance);
b. cell-replacement therapies, including but not limited
to stem cell therapy. This exclusion does not include
blood transfusions, which are covered when medically
necessary;
c. a Condition where the diagnosis is inconclusive, but
where the Treatment protocol is consistent with a
Treatment protocol typically applied to an Condition
which is not covered (e.g. Treatment for coughing
where kennel cough is suspected but not diagnosed or
excluded as a diagnosis);
d. T
reatment for Conditions excluded by the policy and/
or due to complications and/or adverse reactions
arising from any Policy Exclusion;
e. medication not approved or listed by the APVMA
(Australian Pesticides and Veterinary Medication
Authority) unless specifically agreed to by us in writing;
f. the provision of medication(s) for your Pet that covers
a period of more than thirty (30) days beyond the
policy End Date;
g. your decision to pursue a course of Treatment other
than that which was recommended to you by your Vet
unless specifically authorised by us prior to Treatment.
For example: ignoring a Vet’s recommendation to
remove an eye, which then results in extra costs
associated with chronic eye issues; or
h. b
reeding or obstetrics, or Treatment of Conditions
arising as a result of breeding or obstetrics.
42
c. a
dditional costs associated with house calls, phone
consultations and out-of-hours Treatment except
where the Vet believes emergency consultation was
necessary. When not deemed necessary, our liability is
limited to the amount that would have been payable
had the Treatment been provided at a Vet practice
during normal consultation hours;
d. g
enetic/chromosome testing including procedures to
determine the suitability or categorisation of your Pet
for breeding or genealogical purposes; or
e. organ transplant surgery, artificial limbs, external
fixtures (eg wheel chairs), prosthetics, pacemakers
and any associated expenses unless authorised and
agreed to by us in writing prior to any Treatment.
6. Elective Procedures and Treatments
a. r outine examinations; cosmetic procedures;
experimental Treatments or therapies; desexing;
cryptorchidism (undescended testicles); chemical
castration; superlorin implants; hip and elbow scoring;
Elective Treatments, including but not limited to nail
clipping, tail docking, debarking, pre-anaesthetic blood
tests, declawing, ear cropping and nasal fold, skin fold,
stenotic nares and soft palate resections.
7. Your Pet not being protected
a. a
malicious act, deliberate injury or gross negligence
caused by you or anyone living with you; or
b. y
our failure to take all reasonable precautions to
protect your Pet from situations that may result
in injury or Illness (such as ingestion of hazardous
substances) or from aggravating a treated Condition.
43
Section 6 Premiums
8. Policy Conditions
a. any consequential loss, economic or otherwise, loss
of enjoyment or other such loss not mentioned in the
policy; or
b. a
Condition specifically excluded on your Certificate of
Insurance.
Pre-existing Condition review
You may apply to us to review a Pre-existing Condition
exclusion provided that your Vet certifies and provides
(at your expense) veterinary records verifying that
your Pet has been free of clinical signs, symptoms
or recurrence of the Pre-existing Condition (or any
Condition(s) arising directly therefrom) up to the date of
receipt of your Review Application Form, which shall be
no less than a period of eighteen (18) months from the
original policy Commencement Date.
Your request for this review must be made in writing
after the completion of the eighteen (18) month period
using our prescribed Review Application Form available
on our website at www.hif.com.au/pet. The Pre-existing
Condition exclusion(s) shall not be deemed to have been
lifted unless agreed to by us in writing. Agreement to lift
all or part of the exclusion(s) is at our sole discretion and
we are not obligated to provide reasons for declining a
request.
44
Cover under the policy is provided on the
basis that you have paid or agreed to pay
us the premium for the Cover provided.
The amount you pay is shown on your
Certificate of Insurance and includes all
premium, administration fees, commissions
and any applicable government taxes, fees
and/or charges.
6.1 Paying your premium
1. T
he premium is payable when you take out a new
policy and when you renew your policy.
2. You may choose to pay the premium:
• annually by credit card or direct debit; or
• monthly
or fortnightly by instalment by credit card or
direct debit.
3. W
hen premiums are paid monthly or fortnightly by
instalment, claims are paid on the basis that you agree
to pay the remaining premiums for that Policy Period.
If you pay your premium by instalments, you may be
charged a collection fee.
Note: If we accept and pay a claim under the policy, we
may deduct the balance of any outstanding premium
from the claim payment.
45
Section 7 Cancellations
6.2 Paying on the due date
7.1 Cancellation by you
1. Your policy will not operate until you have paid your
premium (or your first instalment if you have elected to
pay by instalments).
You may cancel your policy at any time by giving us notice
in writing of your intention to do so. The cancellation will be
effective at the time the notice of cancellation is received
by us. We will only accept notices of cancellation given in
writing and signed by you. We will not accept cancellation
requests by telephone or email unless agreed to by us.
2. Y
our premium must be paid on or before its due date.
3. If you don’t pay a premium instalment by the due date
then:
• if
the unpaid premium remains in arrears for more
than thirty (30) days we may cancel your policy
without notification; and
at least one instalment has remained unpaid for
• if
a period of at least fourteen (14) days then we may
refuse to pay your claim/s.
4. If we cancel your policy due to non-payment of an
instalment premium you need to be aware that:
benefits or entitlements can be paid under the
• no
policy,
• you
may be refused cover in the future under any
policy administered by PetSure; and
• any
application for general insurance products in the
future may be affected because you had a policy
cancelled as a result of unpaid premiums.
If you return your policy during the 21 day cooling-off period,
we will refund any premiums paid since commencement
or renewal, less any reasonable administrative and other
transaction costs incurred by us, which we are unable
to recover and any taxes or duties that we are unable to
refund. You cannot return your policy if a claim has been
made or other right exercised under the policy.
If you cancel the policy after the cooling off period and
you have paid the annual premium in full, provided no
claim has been made or other right exercised under the
policy, we will refund the premium less an amount that
covers the period for which your Pet was insured, and
any statutory fees. There is no premium refund if you
have been paying your premium by instalments.
If you cancel your policy for whatever reason (other than
the death of your Pet) after having made a claim, no
premium refunds are payable and the remaining premium
for that Policy Period must be paid. Any outstanding premium
may be deducted from any claim payment owed, or
alternatively, charged to your nominated bank/credit card
account. This clause survives termination of this contract.
If you cancel your policy for any reason (other than your
Pet passing away) you will be charged a cancellation fee.
7.2 Cancellation by us
We may cancel your policy where the law allows us to
do so. If we cancel your policy, we will refund any money
we owe you less any non-refundable statutory fees. If we
cancel your policy due to fraud, we will not refund any
money to you.
We may cancel your policy on your behalf if your pet
passes away.
For more information about cancellations refer to Section
6 - ‘Premiums’ on page 45.
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47
Section 8 Claims
8.1 What you need to do
All claims must be completed carefully and honestly and
can be submitted online or by post. If submitting a claim
by post claim forms are available on request by calling
1300 070 946 or can be downloaded from hif.com.au/pet
If submitting a claim by Post
The list below sets out the procedure when submitting a
claim.
• The attending Vet must complete all sections on the
claim form where designated and both you and the
attending Vet must sign the claim form.
How to make a claim and your consent
If submitting a claim online
All claims (online and Post)
• If your Vet has agreed to submit your claim
electronically on your behalf, you agree we are
authorised to receive each such claim submitted.
• All claims must include itemised tax invoice/s,
payment receipt/s and applicable consultation notes.
If submitting a claim by post all claim documentation
must be originals and must be accompanied by a
completed claim form. Incomplete claim forms will
be returned to you and this may result in a delay in
processing your claim. We recommend that you retain
copies of all documentation for your records.
• If submitting a claim for the first time, please include
a full veterinary history from the attending Vet and
any previous Vets who have treated your Pet. Failure
to include this may result in delays in processing your
claim.
• All claims should be submitted to us and received
within ninety (90) days of the relevant Treatment being
provided and all accounts must be paid in full prior to
submission of your claim.
• You agree that your Vet (current or previous) is
authorised to release information and/or records to us
about your Pet.
• You agree that we are authorised to discuss with
the Vet, details relating to your claim or Treatment
provided to your Pet in relation to a claim made under
the policy.
• You agree that we have the right to decline to process
a claim where you or your Vet refuse or are unable
to provide information reasonably requested by us in
order to process your claim.
• We will not reimburse you for the provision of any
information required in the administration or execution
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of the policy nor for the assistance provided to you
in the completion of any forms relating to the policy
including the provision of any information in relation to
a claim made under this policy.
8.2 What we will do
1. We will deal directly with you regarding settlement of
the claim.
2. Unless agreed to by us, we will pay you, not the Vet.
3. If the Vet Expenses:
a. are considered by us to be excessive or
unreasonable; or
b. are higher than the Vet Expenses normally charged
by a general or referral practice; or
c. in our opinion may not be required; or
d. are regarded to be excessive when compared with
the Treatment normally recommended to treat the
same Condition by general or referral practices,
then claim payments will be adjusted and paid
based on the reasonable and customary Treatment
or fees typically charged for the Treatment of that
Condition. We reserve the right to request a second
opinion from a Vet that we choose. If the Vet we
choose does not agree that the Treatment provided
or fees charged were reasonable, we may decide
to pay only the cost of the Treatment that was
necessary and/or reasonable to treat the Condition
(as advised by the Vet from whom we have
requested the second opinion).
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4. W
e will send you a letter/remittance advice regarding
the settlement of your claim that will provide details of
how your claim has been dealt with.
5. If you submit a fraudulent claim, or solicit your Vet
to behave in a fraudulent manner regarding a claim,
then the claim may be denied and we may cancel your
policy altogether. We may also be entitled to reclaim
any payments already made to you in respect of such
claims.
6. W
hen we settle your claim, we reserve the right to
deduct from the benefit amount any amount due to us.
8.4 Our rights of recovery
If we have the right to recover any amount payable under
the policy in relation to a claim from any other person,
you must cooperate with us in any action we may take.
8.5 Other insurance arrangements
If we accept your claim and there is any other similar
insurance under which you are entitled to claim, you are
required to advise us at the time you submit your claim if
you hold such other insurance. Total benefits paid to you
across all insurance cannot exceed your actual expenses.
7. In the event that we pay a benefit contrary to the
Policy Terms and Conditions for whatever reason, this
will not constitute a waiver of our rights to apply the
Policy Terms and Conditions retrospectively as they
stand to any paid claims or to any future claims for that
or any Related Condition. We also reserve our right to
recover from you any benefit amount received by you
as a result of such error.
8.3 Example of how we settle your claim
The following calculations provide examples of how
claims will be settled where Cover is provided (these
examples are indicative of the manner of calculation only
and include GST):
80% Benefit Percentage
50
Total amount of eligible Expenses
paid by you to the Vet
$2,000
Total amount claimable after 80%
Benefit Percentage applied
$1,600
Total payment
$1,600
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Section 9
Direct debit request summary
Section 10
General information
When you provide us with your bank details, you are
instructing us to directly debit the relevant premiums
calculated by us from your nominated account.
Changing level of Cover
If your premium cannot be paid (for example there is not
enough money in your nominated account) your bank
may dishonour that payment, and you may be charged
a dishonour fee by your bank. Neither Hollard, HIF nor
PetSure will be responsible for dishonour fees charged
by your bank or financial institution. If your direct
debit is dishonoured we will automatically retry for the
outstanding amount within fourteen (14) days, and you
may be charged a dishonour fee by PetSure.
If you have concerns about the operation of the direct
debit authority or you subsequently need to change any
aspects of the authority, please notify us.
1. If you opt to transfer your Pet to a level of Cover with
higher or additional benefits (including but not limited
to a higher Benefit Percentage and Benefit Limit)
then the additional or higher benefits will not apply to
claims for Conditions first noted, diagnosed, or treated
prior to the policy upgrade. In such cases, benefits will
be restricted to the lesser of the maximum benefits
payable under the:
a. current level of Cover; or
b. policy that applied during the Policy Period in which
such Condition(s) was/were first noted, diagnosed,
or treated.
For the sake of clarity, maximum benefits referenced
in this section include taking the following factors into
consideration:
the policy Benefit Limit;
applicable sub-limits;
applicable Benefit Percentage; and
any applicable policy exclusions.
2. If you opt to transfer your Pet to a level of Cover with
additional benefits, then the applicable Waiting Period
for the newly selected Cover will apply. You cannot
change your level of cover in a policy period if a claim
has been paid.
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53
Financial Services Guide (FSG)
PetSure and HIF are responsible for this FSG as it
relates to the financial services provided by them. This
FSG provides you with information about the financial
services that they provide in relation to HIF Pet (to help
you decide whether or not to use those services) as well
as information on how they are remunerated in relation
to the services, how they deal with complaints and how
they can be contacted.
In this FSG:
• Hollard means The Hollard Insurance Company Pty
Ltd.
• HIF means Health Insurance Fund of Australia Limited
trading as “HIF”.
• PetSure means PetSure (Australia) Pty Ltd.
• You, and your means the applicant for a HIF Pet policy
and, if a policy is issued, the insured.
HIF Pet is promoted by HIF, insured by Hollard and
administered by PetSure. Full details about these
companies are given at the start of this booklet on
page 3. The HIF Pet PDS including the Policy Terms and
Conditions are set out in this booklet. The HIF Pet PDS
contains information on the benefits and significant
characteristics of the product and is aimed to assist
you in making an informed decision about whether
to purchase it or not. Before you acquire the product,
you should read the PDS carefully and use it to decide
whether to purchase the product.
About Hollard, HIF, PetSure and other relevant
persons/organisations
Hollard is an Australian Financial Services Licensee
(AFSL 241436) authorised to provide advice and deal in
relation to all general insurance products. Hollard is the
insurer and issuer of HIF Pet policies. In providing the
financial services set out in this FSG, Hollard does not
provide personal advice and does not act for you.
PetSure, a related company to Hollard, is an Australian
Financial Services Licensee (AFSL 420183) and is
authorised to deal in and provide general advice on
general insurance products. It administers pet insurance
policies on behalf of the insurer Hollard and determines,
on behalf of Hollard, whether a policy can be issued to
you by Hollard.
PetSure has been given a binding authority by Hollard
which authorises it to enter into, vary and cancel
these policies on behalf of Hollard as if it were Hollard.
PetSure’s authority is subject to the limits of authority
agreed with Hollard. PetSure has also been appointed
by Hollard as its agent to manage, administer and settle
claims made under HIF Pet policies. This means PetSure
makes decisions about claims on behalf of Hollard.
In providing the financial services set out in this FSG
PetSure does not provide personal advice and does not
act for you.
Important information you should know
The organisations in this section have not and will not
consider whether HIF Pet is appropriate for your personal
objectives, financial situation or needs as they do not
provide such services to you. Any information provided
in relation to this product is of a general nature only and
is not based on a consideration of your personal needs,
objectives or financial situation. Therefore you need to
consider the appropriateness of any information given to
you, having regard to your personal circumstances before
buying HIF Pet. You need to read the PDS including the
Policy Terms and Conditions to determine if the product
is right for you. The PDS contains information on the
relevant risks, benefits and significant characteristics
of the product and is aimed to assist you in making an
informed decision about whether to buy it or not. If you
require personal advice, you need to obtain the services
of a suitably qualified adviser.
HIF is an Authorised Representative (Number 1250504)
of PetSure and is authorised to promote HIF Pet which is
issued by Hollard. HIF does not provide personal advice
and does not act for you.
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55
How each party is paid for its services
When you purchase a HIF Pet policy you pay the
premium to Hollard for the product. This amount is
provided to you before the product is purchased.
HIF may receive a commission of up to twenty three
percent (23%) of the net premium (this is the premium
less any government taxes and charges) for promoting
HIF Pet policies. This commission is used by HIF to cover
costs associated with the marketing and distribution of
this product to you and may include any referral fees to
people or organisations that refer new customers to HIF.
HIF staff who provide services in relation to HIF Pet
receive an annual salary from HIF, which includes bonuses
based on performance criteria.
Refer to the “Financial Claims Scheme and Compensation
Arrangements” section on page 17 in the PDS for further
information on Hollard’s compensation arrangements.
Your privacy
Refer to the “Your Privacy” section on page 12 of the
PDS for further information on what we do with your
information.
PetSure receives a portion of the underwriting profit, if
any, for administering HIF Pet products.
How are Complaints resolved?
PetSure may receive an activity payment directly from
HIF for retention and support services in connection with
HIF Pet on behalf of Hollard. The amount of that activity
payment is time based and will be calculated taking into
account time spent handling retention related calls. The
payments to PetSure are not additional charges to you
and are not in addition to the total premium you pay.
Contact details and office hours
You may request particulars about the above
remuneration (including commission) or other benefits
from the relevant entity providing the relevant financial
service; however, the request must be made within a
reasonable time after you have been given this document
and before the relevant financial service has been
provided to you by them. The contact details for each of
HIF and PetSure are set out below.
Compensation Arrangements
The Corporations Act 2001 (Cth) requires Australian
Financial Services licensees to have arrangements for
compensating retail clients for losses they suffer as a
result of a breach by the licensee or its representatives of
Chapter 7 of that Act, unless an exemption applies.
56
To this end HIF and PetSure have Professional
Indemnity Insurance in place which meets the legislative
requirements covering their activities and includes the
conduct of any employees who are no longer employed
by HIF or PetSure but were so at the time of the relevant
conduct.
Refer to the “If you have a complaint” section on page 16
of the PDS for further information on how complaints are
dealt with.
For more information about HIF Pet and PetSure:
Call us: 1300 070 946 Monday to Friday
(except public holidays) 8:30am to 8:00pm (AEST)
Write to us:
HIF Pet Locked Bag 9021 Castle Hill, NSW 1765
Visit us: hif.com.au/pet
Please retain this document for your future reference.
Authorised for issue
This FSG was prepared by PetSure and HIF (as it relates
to the financial services provided by them) on 28/4/17
and Hollard has authorised the distribution of this FSG by
them.
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1300 070 946
Operation hours
Monday to Friday
(except public holidays)
8:30am to 8:00pm (AEST)
Saturday
Closed
Sunday
Closed
hif.com.au/pet
Every hour of every day (24/7)
The information contained in this brochure
supersedes all previously published material.
Health Insurance Fund of Australia Limited trading
as “HIF” ABN 84 607 276 950
Issued by The Hollard Insurance Company Pty Ltd
ABN 78 090 584 473 AFSL 241436